Truckers Drive Their Own Assessment for Obstructive Sleep Apnea: A Collaborative Approach to Online Self-Assessment for Obstructive Sleep Apnea

B. Smith and B. Phillips, "Truckers Drive Their Own Assessment for Obstructive Sleep Apnea: A Collaborative Approach to Online Self-Assessment for Obstructive Sleep Apnea", Journal of Clinical Sleep Medicine, vol. 7, no. 3, pp. 241-245, 2011.

Abstract

Background. Commercial motor vehicle drivers are at an increased risk for Obstructive Sleep Apnea (OSA). The Federal Motor Carrier Safety Administration (FMCSA) Medical Review Board has recommended that commercial motor vehicle drivers undergo testing for OSA if they have a positive Berlin Questionnaire or a BMI > 30 kg/m². We developed an online screening tool based on the Berlin Questionnaire for anonymous use by commercial drivers to assess their risk of OSA prior to their required FMCSA physicals.

Methods. We based the survey on the Berlin Sleep Questionnaire. The survey was hosted on the Truckers for a Cause Chapter of Alert Well and Keeping Energetic of the American Sleep Apnea Association (TFAC-AWAKE) organization website, and was promoted through the TFAC’s XM radio, word of mouth and trucking industry press contacts.

Results. 595 individuals completed the survey. Of these, 55.9% were positive on the Berlin, 78.3% had either hypertension or obesity, 69.6% were obese, 47.6% had a BMI > 33 kg/m², and 20.5% reported falling asleep at stoplights.

Conclusions. Some commercial drivers willingly assess their OSA risk anonymously online, and a majority of those who do so are obese, have positive Berlin screening questionnaires, and would be required to undergo polysomnography if recommendations made to the FMCSA regulation. In contrast to reported behavior during actual Commercial Driver Medical Examinations physicals, some commercial drivers will report OSA symptoms if it is “safe” to do so. Sleep health professionals need expedient, non-punitive methods to keep commercial motor vehicle drivers healthy and driving and to raise drivers’ awareness of the dangers of drowsy driving and unhealthy lifestyles.

References

^[1] Tregear S, PhD; James Reston J, Schoelles K, Phillips B, Obstructive Sleep Apnea and Risk of Motor Vehicle Crash: Systematic Review and Meta-analysis, JCSM 2009; 5 (15) : 573-581.

^[2] Hartenbaum N, Collop N, Rosen IM, Phillips B, et al. Sleep apnea and commercial motor vehicle operators: Statement from the joint task force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation. Chest. 2006;130 (3):902-5.

^[3] Ellen RB, Marshall SC, Palayew M, Molnar FJ et al. Systematic review of motor vehicle crash risk in persons with sleep apnea. JCSM. 2006; 2(2): 193-200.

^[4] Tregear S, PhD; James Reston J, Schoelles K, Phillips B, Continuous Positive Airway Pressure Reduces Risk of Motor Vehicle Crash among Drivers with Obstructive Sleep Apnea; Systematic Review and Meta-analysis. Sleep 2010; 33(10): 1373-1380.

^[5] http://www.fmcsa.dot.gov/facts-research/facts-figures/analysis-statistics/cmvfacts.htm

^[6] Howard ME, Desai AV, Grunstein RR, et al. Sleepiness, sleep-disordered breathing, and accident risk factors in commercial vehicle drivers. American Journal of Respiratory and Critical Care Medicine. 2004;170 (9):1014-21.

^[7] Moreno CR, Carvalho FA, Lorenzi C, et al. High risk for obstructive sleep apnea in truck drivers estimated by the Berlin Questionnaire: prevalence and associated factors. Chronobiology International. 2004;21 (6):871-9.

^[8] Pack AI, Maislin G, Staley B, et al. Impaired performance in commercial drivers: role of sleep apnea and short sleep duration. Am J Respir Crit Care Med. 2006;174 (4):446-54.

^[9] http://www.fmcsa.dot.gov/rules-regulations/topics/medical/Overview-FMCSAMedStds-Process.pdf.

^[10] http://www.fmcsa.dot.gov/rules-regulations/TOPICS/mep/report/Sleep-MEP-PanelRecommendations-508.pdf

^[11] Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7):485-91.

^[12] http://www.mrb.fmcsa.dot.gov/documents/Fin_Meet_Min_Jan28_2008MRB_Meet_Revised11-24-09.pdf

^[13] Agresti, A. Building and applying logistic regression models. An Introduction to Categorical Data Analysis. Wiley: Hoboken, New Jersey. 2007.

^[14] Parks P, Durand G, Tsismenakis AJ, Vela-Bueno A, Kales S. Screening for obstructive sleep apnea during commercial driver medical examinations. J Occup Environ Med. 2009;51 (3):275-82.

^[15] Talmage JB, Hudson TB, Hegmann KT, Thiese MS. Consensus criteria for screening commercial drivers for obstructive sleep apnea: evidence of efficacy. J Occup Environ Med. 2008;50 (3):324-9

^[16] http://www.cdc.gov/mmwr/pdf/wk/mm59e0803.pdf

^[17] Hwang KO, Hamadah AM, Johnson CW, Thomas EJ, Goodrick GK, Bernstam EV. Screening for obstructive sleep apnea on the internet: randomized trial. Am J Med 2009;122 (10):961.e1-6.

^[18] Durand G, Kales SN. Obstructive sleep apnea screening during commercial driver medical examinations: a survey of ACOEM members. J Occup Environ

Med. 2009;51(10):1220-6.

^[19] Stevens, S.S. On the Theory of Scales of Measurement, Science 1946;103 :677-80.